BAS-6 BAS 6 - CBAS Agreement Form

OMB Control No.: 0607-151 Expiration Date: xx-xx-2024
FORM

BAS-6

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

BOUNDARY AND ANNEXATION SURVEY (BAS)

(07/28/2021)

U.S. CENSUS BUREAU

CONSOLIDATED BAS (CBAS) AGREEMENT FORM
To sign up for the Consolidated BAS (CBAS) program, please complete this form.
1.) Reach out to the BAS Contacts for the governments in your county's jurisdiction. Email to request BAS Contact information.
2.) Complete the Participation Roster below as you communicate with the BAS Contacts for the governments in your county's jurisdiction.
3.) Return the completed CBAS Form by email to

GENERAL
INSTRUCTIONS

Name of county, parish, borough or equivalent area

STATE CODE

BAS ID
Section 1

State

COUNTY CODE

CBAS CONTACT MAILING ADDRESS (Address where Consolidated BAS materials should be sent) – Please fill in contact information below.

Name:

Address:

Position:
Department:

City:

Telephone:

(

)

–

Fax:

(

)

–

Ext:

ZIP code

State:
E-mail:

Instructions for filling out this form:
1.) Enter the BAS ID and Government Name, including the type of government, such as "city", "town", "township" for the governments in your county's jurisdiction.
2.) Enter a Y (Yes) or N (No) in the "Agreed" column to note each contact's response to participating in the CBAS program.
3.) Fill in the Contact Name, Position, and Phone Number of the contact person you spoke with from each government. Please provide this information for all governments.
4.) Enter the Date that you spoke with each government contact in the "Date of Contact" column.
Section 2
BAS ID

PARTICIPATION ROSTER
Government Name

Agreed?
Y/N

Contact Name

Position

Phone Number

Date of
Contact

We estimate that participating in the Boundary and Annexation Survey will take 7.5 hours on average. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, using Paperwork Reduction Project 0607-0151 as the subject, to . This collection has been approved by the
Office of Management and Budget (OMB). The eight-digit OMB approval number that appears at the upper right of the form confirms this approval. If this number were not displayed, we could not
conduct this survey. The Census Bureau conducts this survey under the legal authority of the Title 13 United States Code, Section 6.

Section 2
BAS ID

PARTICIPATION ROSTER – Continued
Government Name

Agreed?
Y/N

Contact Name

FORM BAS-6 (07/28/2021)

For further information, please contact the BAS team email at [email protected]. Please reference "CBAS" in the subject of your email.

Position

Phone Number

Date of
Contact

Section 2
BAS ID

FORM BAS-6 (07/28/2021)

PARTICIPATION ROSTER – Continued
Government Name

Agreed?
Y/N

Contact Name

Position

Phone Number

Date of
Contact